Why Choose an Allergist for your Allergy and Asthma?

Allergies and asthma are both chronic conditions, and warrant visiting a specialist for the best management. However, with so many specialists out there, how do you know which one to choose?  Read the FAQ below.

My allergies bother my ears, nose and throat – doesn’t this mean I should see an ear, nose and throat doctor?

Many times, patients go directly to an ear, nose and throat (ENT) doctor for their allergy symptoms. After all, don’t allergies bother your ears, nose and throat?

Ear, Nose and Throat doctors are surgeons who specialize mainly in structural problems that can be corrected with surgery. But many of these problems, such as difficulty breathing through the nose, or having a raspy voice or having trouble hearing, are actually due to allergies.  Allergies, eczema, and asthma are all chronic conditions that fall under the same umbrella of allergy medicine, and more than 50% of sinus problems are caused by allergies.  The other 50% are often caused by a combination of both allergy and non-allergy related problems.

Allergists and otolaryngologists (ENT doctors) specialize in different areas. Allergists specialize in diagnosing and treating underlying medical causes of allergic disease, including nasal inflammation, asthma, and food reactions. They go through four years of medical school, and three to four years of residency, followed by a two year allergy-immunology fellowship. They must become board certified with the American Board of Internal Medicine, and/or the American Academy of Pediatrics, along with the American Board of Allergy and Immunology.

ENTs deal with structural problems (ie, with bones or cartilage) that affect the sinuses, swallowing, speech, hearing, and balance. Because allergies affect so many people (up to 1 in 5 Americans), ENTs also receive limited allergy training. However, this training often occurs in two weeks or less, which is not much time to cover how to correctly perform and interpret allergy tests, and how integrate the intricacies involved in best treating a patient’s allergies. Allergists receive years of specialty training, and are experts in managing all the ways allergies affect the skin, sinuses, eyes, ears, lungs and stomach.

Wouldn’t it be better to have a surgery to correct my sinus problems once and for all?

When a structural problem exists, an allergist will refer you to an otolaryngologist. However, more than half the time, sinus problems are caused by allergies. Since the underlying causes of sinus symptoms and disease are most frequently caused by allergies, an allergist should be seen first.

What should I expect at an allergy visit?

At your first allergy visit, you can expect the following.

• Detailed medical history, including medication review.
• Review of previous skin or blood test results.
• Review of previous health conditions, including hospitalizations or emergency visits for allergies.
• Order allergen-specific Immunoglobulin E (IgE) levels, if needed.
• Skin testing, if needed.
• Identify food allergens and severity.
• Develop a management plan – this could involve avoiding the allergen, taking a medication, and/or doing immunotherapy.
• Develop an anaphylaxis plan (avoidance and management), including use of epinephrine auto injector.

My doctor did bloodwork, showing I have food allergies. Now what?

This is where years of allergy and immunology training come into play. Oftentimes, laboratory studies (blood or RAST (radioallergosorbent) testing) do not tell the whole story. Skin prick testing provides the most accurate test results, and oral food challenges may be necessary to accurately diagnose food allergies. Allergists are trained to assess the full history and clinical picture of allergies, and not only base treatment on a blood test. A physician with limited allergy training may tell a patient to avoid certain foods based on a blood test, when this is not actually necessary. These dietary restrictions can add undue stress to a family, and it is worth consulting an allergist, especially if you have never experienced allergic symptoms after eating a certain food.

In recent news, a breakthrough new study also demonstrated that infants with a slight peanut sensitivity who were exposed to peanuts early on actually developed fewer allergies than infants who were kept from being exposed to peanuts. Visit our blog to learn more. These steps should only be taken in the safety of a medical setting, in the presence of a board certified allergist.

Does it cost more to have allergy shots done by a specialist?

All allergy shots are reimbursed the same amount by insurance companies (according each company’s reimbursement policies), no matter what type of physician administers them. However, allergists give allergy shots at the demonstrated effective dose range for each extract, in contrast to some offices and companies that administer the shots at more dilute doses for the same price. This means you could actually be paying the same amount of money for a less effective treatment. Ask your physician what guidelines they are basing their allergy shots on, to ensure you receive your full benefit.

References:

Cox L, Nelson H, Lockey R.  Allergen Immunotherapy: A Practice Parameter Third Update.  J Allergy Clin Immunol.  2011;127(1):S1-S55.

Hudson Allergy.  What’s the Difference Between an Allergist and an ENT?  http://hudsonallergy.com/whats-difference-allergist-ent/

The Allergy, Asthma & Sinus Center.  Allergist or ENT?  http://www.allergyasc.com/allergist-or-ent.html.